Basic Information
Provider Information
NPI: 1003005729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALNOHA
FirstName: WADE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.A.-C.
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 575 COPELAND MILL RD
Address2: SUITE 1D
City: WESTERVILLE
State: OH
PostalCode: 430818977
CountryCode: US
TelephoneNumber: 6147940481
FaxNumber: 6147943711
Practice Location
Address1: 500 S CLEVELAND AVE
Address2:  
City: WESTERVILLE
State: OH
PostalCode: 430818971
CountryCode: US
TelephoneNumber: 6147940481
FaxNumber: 6147943711
Other Information
ProviderEnumerationDate: 10/18/2007
LastUpdateDate: 01/31/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-3187NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X50.002685OHN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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